23例脊柱布氏杆菌病的临床诊治分析

Diagnosis and treatment of 23 patients with spinal brucellosis disease

目的回顾我院收治的脊柱布氏杆菌病患者的病例资料,分析脊柱布氏杆菌病诊断方法、治疗措施。方法收集我院自2014年9月~2016年3月收治的23例脊柱布鲁氏杆菌病患者的病例资料,分析总结患者病例资料特点。结果男15例、女8例,颈椎2例、胸椎2例、腰椎19例、骶椎3例、髂腰肌1例(其中1例同时累及胸腰椎,3例同时累及腰骶椎);23例患者均有颈、胸或腰背部疼痛病史,有牛羊接触史,MRI检查提示存在感染性病变,23例患者经血清学检查、细菌培养确诊后,行药物保守治疗(19例)或手术治疗(4例),均获得了满意效果。结论颈胸腰背部疼痛患者伴有发热,MRI提示存在感染性病变,既往有牛羊接触史,在诊断时要高度怀疑脊柱布氏杆菌病,该类患者可行相关血清学检查、细菌学检查明确诊断,大多数患者经药物保守治疗可获得满意效果,伴有脓肿形成压迫神经或脊髓压迫者经积极手术治疗,大多数患者也可获得满意效果。

Objective To review the clinical data of patients with spinal brucellosis disease in our hospital and to analyze the diagnosis and treatment. Methods From September 2014 to March 2016,23 cases of patients with spinal brucellosis cases in our hospital. Their medical records were analyzed and summarized. Results There were 15 males and 8 females. There were 2 cases of cervical vertebrae, 2 cases of thoracic vertebrae, 19 cases of lumbar vertebrae, 3 cases of sacral vertebrae, 1 cases of iliac and lumbar muscles were involved （Among them, 1 cases were involved in the thoracic and lumbar vertebrae at the same time, and 3 cases were involved in the lumbar and sacral vertebra at the same time）.23 patients complained mainliy for neck, thoracic or lumbar back pain, and all had a history of exposure to cattles and sheep. MRI examination suggested the presence of infectious lesions.23 patients were diagnosed through serological examination, bacterial culture. 19 patients were treated by oral medicine and 4 patients underwent surgery. Good prognosis was achieved in all patients. Conclusion The patient have lhe following characteristics, spinal brucellosis should be highly suspected ：have cervical thoracic back pain patients with fever,MRl suggests the presence of infectious diseases, have a history of exposure to cattles and sheep. The patients are diagnosed through serological examination, bacterial culture. Most of the patients can achieve good prognosis by conservative treatment .The patients with nerve or spinal cord compression were treated by active surgical treatment, and satisfactory results were obtained.